ACALASIA NA DOENÇA DE CHAGAS É DIFERENTE DE ACALASIA IDIOPÁTICA? EXPERIÊNCIA DO HOSPITAL DE CLÍNICAS DE PORTO ALEGRE

Objetive: The objective of this study is to evaluate the differences between achalasia in Chagas’ disease and idiopathic achalasia in patients admitted to the Hospital de Clínicas de Porto Alegre, by analyzing epidemiologic, clinic, radiologic and manometric findings.Methods: Patients referred to the Hospital de Clinicas de Porto Alegre between November 1996 and December 2001 with suspicion of achalasia, later confirmed by esophageal manometry, were included in the study. In addition to manometric and radiologic findings, patients were assessed for age, sex, symptomsand symptomatic period.Results: Among 51 patients, nine (18%) presented positive serology for Chagas’ disease and 42 (82%) presented negative serology. The latter were considered carriers of idiopathic achalasia. The mean age of patients with achalasia in Chagas’ disease was 62 ± 15 years, while the mean age in the idiopathic group was 43 ± 18 years (P < 0.02). The symptomatic period for patients with achalasia in Chagas’ disease was 74 ± 47 months, and in the idiopathic group, 49 ± 35 months (P < 0.05). Dysphagia, regurgitation, thoracic pain and weight loss, values at the lower esophageal sphincter (basal pressure, post-deglutitive relaxation pressure/duration and total length) and at the esophageal body (amplitude and duration of the post-deglutitive waves) were similar in both groups.Conclusions: The only statistically significant differences found between the two groups were age and length of the symptomatic period, significantly greater in patients with achalasia in Chagas’ disease. These data suggest a greater resistance to the symptoms in older patients.Objetivo: O presente trabalho tem como objetivo avaliar as diferenças entre a acalasia chagásica e a idiopática em pacientes do Hospital de Clínicas de Porto Alegre, através da análise de achados epidemiológicos, clínicos, radiológicos e manométricos.Métodos: Foram estudados pacientes encaminhados ao Hospital de Clínicas de Porto Alegre, entre novembro de 1996 e dezembro de 2001, com suspeita de acalasia, posteriormente, confirmada por manometria esofágica. Além das características manométricas e radiológicas, os pacientes foram avaliados quanto a idade, sexo, sintomas e tempo de evolução.Resultados: Entre 51 pacientes, nove (18%) tiveram sorologia positiva para doença de Chagas e 42 (82%) sorologia negativa. Indivíduos com sorologia negativa foram considerados portadores de acalasia idiopática. Pacientes com acalasia chagásica tinham média de idade de 62 ± 15 anos e os com idiopática 43 ± 18 anos (P < 0,02). O período de evolução dos sintomas em pacientes com acalasia chagásica foi de 74 ± 47 meses e nos idiopáticos 49 ± 35 meses (P < 0,05). Disfagia, regurgitação, dor torácica e emagrecimento, valores do esfíncter esofágico inferior (pressão basal, pressão e duração de relaxamento pós-deglutição e comprimento total) e do corpo esofágico (amplitude e duração das ondas pós-deglutição) foram similares em ambos os grupos.Conclusões: As únicas diferenças estatisticamente significativas encontradas entre os dois grupos foram a média de idade e o período de evolução dos sintomas, maiores nos pacientes chagásicos. Esses dados permitem especular sobre uma maior tolerância aos sintomas nos pacientes com idade mais avançada

Cesarean delivery is associated with an increased risk of obesity in adulthood in a Brazilian birth cohort study

Background: Obesity is epidemic worldwide, and increases in cesarean delivery rates have occurred in parallel. Objective: This study aimed to determine whether cesarean delivery is a risk factor for obesity in adulthood in a birth cohort of Brazilian subjects. Design: We initiated a birth cohort study in Ribeirao Preto, southeastern Brazil, in 1978. A randomly selected sample of 2057 subjects from the original cohort was reassessed in 2002-2004. Type of delivery, birth weight, maternal smoking, and schooling were obtained after birth. The following data from subjects were collected at 23-25 y of age: body mass index (BMI; in kg/m(2)), physical activity, smoking, and income. Obesity was defined as a BMI >= 30. A Poisson multivariable model was performed to determine the association between cesarean delivery and BMI. Results: The obesity rate in adults born by cesarean delivery was 15.2% and in those born by vaginal delivery was 10.4% (P = 0.002). Adults born by cesarean delivery had an increased risk (prevalence ratio: 1.58; 95% CI: 1.23, 2.02) of obesity at adulthood after adjustments. Conclusion: We hypothesize that increasing rates of cesarean delivery may play a role in the obesity epidemic worldwide. Am J Clin Nutr 2011;93:1344-7.Fundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP)[93/0525-0]Fundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP)[97/09517-1]Fundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP)[00/09508-7]CNPq Conselho Nacional de Desenvolvimento Cientifico e TecnologicoFAEPA-HCFMRPUSP, Brazi

Delivery Mode and the Transition of Pioneering Gut-Microbiota Structure, Composition and Predicted Metabolic Function

Cesarean (C-section) delivery, recently shown to cause excess weight gain in mice, perturbs human neonatal gut microbiota development due to the lack of natural mother-to-newborn transfer of microbes. Neonates excrete first the in-utero intestinal content (referred to as meconium) hours after birth, followed by intestinal contents reflective of extra-uterine exposure (referred to as transition stool) 2 to 3 days after birth. It is not clear when the effect of C-section on the neonatal gut microbiota emerges. We examined bacterial DNA in carefully-collected meconium, and the subsequent transitional stool, from 59 neonates [13 born by scheduled C-section and 46 born by vaginal delivery] in a private hospital in Brazil. Bacterial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq (San Diego, CA, USA) platform. We found evidence of bacterial DNA in the majority of meconium samples in our study. The bacterial DNA structure (i.e., beta diversity) of meconium differed significantly from that of the transitional stool microbiota. There was a significant reduction in bacterial alpha diversity (e.g., number of observed bacterial species) and change in bacterial composition (e.g., reduced Proteobacteria) in the transition from meconium to stool. However, changes in predicted microbiota metabolic function from meconium to transitional stool were only observed in vaginally-delivered neonates. Within sample comparisons showed that delivery mode was significantly associated with bacterial structure, composition and predicted microbiota metabolic function in transitional-stool samples, but not in meconium samples. Specifically, compared to vaginally delivered neonates, the transitional stool of C-section delivered neonates had lower proportions of the genera Bacteroides, Parabacteroides and Clostridium. These differences led to C-section neonates having lower predicted abundance of microbial genes related to metabolism of amino and nucleotide sugars, and higher abundance of genes related to fatty-acid metabolism, amino-acid degradation and xenobiotics biodegradation. In summary, microbiota diversity was reduced in the transition from meconium to stool, and the association of delivery mode with microbiota structure, composition and predicted metabolic function was not observed until the passing of the transitional stool after meconium

Type of delivery according to birth variables, 1978/79 Ribeirão Preto birth cohort.

*<p>Totals may not add up to 2063 because of missing values.</p>**<p>P-value refers to the chi-squared test.</p

Comparison of birth characteristics of those followed-up with those not followed-up in early adulthood.

*<p>Totals may not add up to 6,484 because of missing values.</p>**<p>P-value refers to the chi-squared test.</p><p>1978/89 Ribeirão Preto birth cohort, 2002/2004.</p

Association of type of delivery with indicators of increased adiposity in young adults.

*<p>Increased WC: ≥90 cm for men and ≥80 cm for women);</p>†<p>RR = Incidence rate ratio; 95%CI = 95% Confidence interval.</p>‡<p>Increased WHtR: >0.5;</p>§<p>Increased WHR: ≥0.90 for men and ≥0.85 for women;</p>#<p>Increased TSF and SSF: >90th percentile of the study population;</p>∞<p>Birth weight; type of delivery; sex; maternal schooling; maternal smoking during pregnancy; parity; maternal age and gestational age as a continuous variable.</p><p>Ribeirão Preto, 2002/04.</p

Distribution of birth variables according to the presence of indicators of increased adiposity in young adults.

*<p>Increased WC: ≥90 cm for men and ≥80 cm for women);</p>†<p>Increased WHtR: >0.5;</p>‡<p>Increased WHR: ≥0.90 for men and ≥0.85 for women;</p>§<p>Increased TSF and SSF: >90th percentile of the study population.</p><p>Ribeirão Preto, 2002/04.</p